Active NPI
Bi-State Orthotics & Prosthetics
- Prosthetic/Orthotic Supplier
- Belleville, IL
National Provider Identifier
1154462950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- BI-STATE ORTHOTICS & PROSTHETICS
- Practice address
- 6400 W Main St
Suite 3G
Belleville, IL 62223-3806 - Phone
- (314) 843-2664
- Fax
- (314) 842-3866
- NPI assigned
- Feb 12, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Michael J Nieder, C.O.
- Title
- Vice President
- Phone
- (314) 843-2664
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | Primary |
Addresses
Primary practice location
6400 W Main St
Suite 3G
Belleville, IL 62223-3806
Mailing address
12660 Lamplighter SQR Shppng Ctr
Suite J
Saint Louis, MO 63128-2761
Phone (314) 843-2664
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8221629 | Other | IL | BCBS OF IL |
| 122758 | Other | MO | BCBS OF MO |
National Provider Directory
National Provider Directory- Tax ID family
- Bi-State Orthotics and Prosthetics
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Prosthetic/Orthotic Supplier
- Saint Louis, MO
- NPI 1487816583
Locations
6400 W Main St
Ste 3G
Belleville, IL 62223
Phone (314) 843-2664
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214438400000",
"number": "1154462950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12660 LAMPLIGHTER SQR SHPPNG CTR",
"address_2": "SUITE J",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282761",
"telephone_number": "314-843-2664",
"fax_number": "314-842-3866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6400 W MAIN ST",
"address_2": "SUITE 3G",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622233806",
"telephone_number": "314-843-2664",
"fax_number": "314-842-3866"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BI-STATE ORTHOTICS & PROSTHETICS",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-12",
"last_updated": "2008-06-26",
"status": "A",
"authorized_official_last_name": "NIEDER",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "314-843-2664",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "C.O."
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "8221629",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MO",
"identifier": "122758",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.